Appropriate Molds for Skin Testing (Bush)


  • Fungal allergenic extracts for diagnostic (much less therapeutic) use are limited by variability in composition, lack of standardization, and frequent cross-reactivity. Also changes in nomenclature adds to the confusion.

  • For a general screening panel (prick skin testing), use:
    • Alternaria alternata
    • Aspergillus fumigatus
    • Penicillium chrysogenum (notatum)
    • Cladosporium herbarum, cladosporiodes, sphaerospermum (Hormodendrum hordei) (consider mix)
    • Drechslera (Curvularia) spicifera or Bipolaris sorokiniana (Helminthosporium sativum)
    • Epicoccum nigrum

  • For the expanded panel use:
    • Fusarium solani, vasoinfectum, moniliforme (consider mix)
    • Mucor racemosus
    • Aureobasidium (Pullularia) pullulans
    • Aspergillus flavus, niger (consider mix)
    • Trichophyton tonsurans
    • Chaetonium globosum
    • Candida albicans


Note:
  • Cross-reactivity
    • Phoma and Stemphyllium share allergens with Alternaria
    • Aspergillus and Penicillium have cross-reactive allergens
  • Esch: Cross-reactivity among the fungi is highly variable, possibly due to differences in fungal strains, and the cultivation/manufacturing methods used by different manufacturers of fungal extracts; in some cases, even different manufacturers’ products labeled as the same fungal species do not guarantee allergenic cross-reactivity



commonly_encountered_fungi.png
From R. Bush (AAAAI 2012)


Molds Isolated from Christmas Trees

  • Hypothesized as a cause of "Christmas Tree Syndrome", in which allergic respiratory diseases are exacerbated during the holiday season
Christmas tree molds.png


Molds Isolated from Classrooms

  • In a study of 12 inner city classrooms in the Northeast US, predominant mold types recovered were:
    • Cladosporium
    • Aspergillus/Penicillium (grouped together because of morphologic similarity) - most prevalent of the traditional ‘indoor’ molds, found most consistently (in 88% of classrooms) and at the highest concentrations
      • In contrast, Alternaria was found in 29% of rooms and not in high concentrations
    • Other molds commonly associated with indoor water damage or decay such as Stachybotrys, Chaetomium, Scopulariopsis, and Bispora were found in low concentrations or were rarely recovered

References